PEPFAR South Africa Update and COP17 Planning

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South Africa Overview

• South Africa has the largest HIV epidemic in the world with 3.4 million people on ART; 3.6 million people not on ART

• Heterogeneity in prevalence across provinces (8-28%) and districts (6-46%)

• High incidence in young women, esp. in ages 20-24

• Low MTCT; strong OVC service delivery; and commitment to systems strengthening

• Ambitious scale up of VMMC

• Strong South Africa Government partnership with PEPFAR

PFIP RSA - USG Bilateral Management Structures

PF

Management Committee

Clinical Services Work Stream Prevention and OVC Work Stream

PFIP Steering

Committee

PEPFAR’s 3 Guiding Pillars Delivering an AIDS-Free Generation with Sustainable Results

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Accountability

Demonstrate cost-effective

programming that maximizes the

impact of every dollar invested

Transparency

Demonstrate increased

transparency with validation and

sharing of all levels of program data

Impact

Demonstrate sustained control of the epidemic – save lives and avert new

infections

AIDS-free Generation

PEPFAR’s Five Key Agendas Translating the 3 Guiding Pillars to Results

Blueprint for an AIDS-free Generation

Impact Agenda

Controlling the epidemic

Efficiency Agenda

Saving lives through smart investments

Sustainability Agenda

Sharing responsibility, advancing progress Partnership

Agenda

Working together towards an AIDS-Free

Generation

Human Rights Agenda

Securing, protecting, & promoting human rights

Policies and Program Guidance

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• South Africa National Development Plan and National HIV/TB Strategic Plan

PEPFAR 3.0 - Agendas

Global/Multilateral

Guidance and

Best Practice

Aligning with Evidence-Based Strategic Decisions using the Investment Case

Meyer-Rath G, Chiu C, Johnson L, Sumner T, Pretorius C, Guthrie T, Pillay Y, Abdullah F, Kiwango E, on behalf of the

Investment Case Task Team and Steering Committee: Optimising South Africa’s HIV Response: Results of the HIV

and TB Investment Case. Abstract no. 115 (oral presentation), CROI 2016). 8

• TB Screening. TB symptom screening for all PLHIV, children, pregnant women, prisoners, miners, and peri-mining community members.

• HIV Testing. HIV testing for all TB suspects and immediate ART for all co-infected patients. INH prophylaxis for all HIV+ populations per national guidelines.

• Treatment Completion. Active follow-up of co-infected patients to ensure treatment completion.

• Diagnostics. Laboratory investments for TB diagnostics.

TB/HIV

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Target Population Service Community Facility

Newly Diagnosed

Test & Offer X

Fast-track initiation X

Adherence counselling and education X

Disclosure support X

TX_NEW support groups X X

Interactive reminders (SMS, social media apps, CHW call) X X

Stable

Decanting Patients X

Adherence Clubs X

2-3 month drug supply X

Spaced/Fast Lane Appointments X

Community-based dispensation of ARVS (clubs, PDUs)

X

Patient Services through GPs X

Unstable patients

Regular appointment reminders until stable X X

Enhanced Adherence Counseling X X

Tracking and Tracing LTFU X

Differentiated Service Packages for Adherence/ Retention

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KP: Continuum of Care Indicators

Higher HTC, Lower linkage

to treatment

FSW MSM

0%

5%

10%

15%

20%

25%

30%

Aware HIV+ Linked to Care On ART

Gert Sibande Ehlanzeni

Lower HTC, Higher linkage

to treatment

She Conquers

Objectives: • Decrease new HIV infections in girls and young women. • Decrease teenage pregnancies, in particular to decrease

the number of deliveries in girls less than 18 years of age. • Keep girls in school until matric, and increase the retention

of adolescent girls and young women in school. • Decrease sexual and gender based violence amongst

adolescent girls and young women. • Increase economic opportunities for young people,

particularly for young women.

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DREAMS Initiative

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PEPFAR Update: -COP15 results -COP16 Budget and plan -COP17 Planning Timeline -Information resources

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South Africa APR16/COP15 (Sept 2016):

Top-Line Summary

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SNU Types APR16 Results (COP15) FY16 Targets (COP16) FY17 Targets

HTC_POS TX_NEW TX_CURR HTC_POS TX_NEW TX_CURR HTC_POS TX_NEW TX_CURR

Scale-up

Saturation (4) 343,370 201,062 953,646 260,895 385,552 1,112,599 263,277 325,836 1,434,550

Scale-up

Aggressive

(23)

517,921 344,668 1,747,605 622,198 527,085 1,970,907 521,570 632,489 2,437,557

Sustained (9) 113,649 79,897 443,846 44,306 61,927 330,650 - - -

Centrally

Supported (16) 14,425 13,097 260,848 27,496 2,143 5,742 - - -

Total 989,365 638,724 3,405,945 954,895 1,021,705 3,356,961 784,847 958,325 3,872,107

% of target 103.6% 62.5% 101.5%

0%

20%

40%

60%

80%

100%

120%

7,400,000

7,600,000

7,800,000

8,000,000

8,200,000

8,400,000

8,600,000

8,800,000

9,000,000

9,200,000

HTC

% o

f Ta

rget

Ind

ivid

ual

s

FY 2016 Targets FY 2016 Results % of target achived

0%

20%

40%

60%

80%

100%

120%

-

500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

HTC_POS Tx_New Tx_Curr Viral Load VirallySuppressed

% o

f Ta

rget

Ind

ivid

ual

s

FY 2016 Targets FY 2016 Results % of target achived

Care & Treatment Program Cascade, Focus Districts (APR16)

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• HIV Testing Services: 10,368,789 (121%)

• Positive Result: 989,365 (104%)

• High yield in Saturation Districts

• Saturation: 12.6% (343,370 positives)

• Aggressive: 8.5% (517,921 positives)

• Non-Focus: 9.3% (128,074 positives)

• Majority (19/27) of Districts underachieved Positive Result targets

• Saturation: 343,359 (131%)

• Aggressive: 518,002 (80%)

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HIV Testing Services: Focus Districts

New on Treatment: Focus Districts

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0

20000

40000

60000

80000

100000

120000

140000

160000

Target Result

‘Linkage’ to Treatment (i.e. HTC_POS->TX_NEW)

• TX_NEW: 638,724 (64.6% of HTC_pos) – Scale-up saturation:

201,062/343,359 (58.6%);

• district median (IQR): 65.8 (58.3-79.3)

– Scale-up aggressive: 344,668/518,002 (66.5%);

• district median (IQR): 62.3 (57.2-76.4)

– Non-focus: 92,994/128,058 (72.7%);

• district median (IQR): 64.7 (57.3-78.8)

• TX_NEW ‘linkage’ appears similar to previous reporting

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Care and Treatment Program Cascade PEPFAR South Africa, HTC and TX Results (APR FY16)

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10,368,789

989,365 639,134

3,373,857

1,502,691 1,330,226

8,577,018

954,895 1,021,705

3,356,961

2,335,751 2,062,038

121%

104%

63%

101%

64% 65%

0%

20%

40%

60%

80%

100%

120%

140%

0

2,000,000

4,000,000

6,000,000

8,000,000

10,000,000

12,000,000

HTC HTC_POS TX_NEW TX_CURR TX_VIRAL TX_UNDETECT

FY16 Results FY16 Targets % Achieved

Care and Treatment Program Cascade PEPFAR South Africa, Linkage to Treatment (APR16)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

0

20000

40000

60000

80000

100000

120000

140000

Lin

kage

HTC-POS TX_NEW 90 90 90 Target FY16 Linkage21

USG Remediation Process for IPs for TX-New • Prioritization of districts

• Facility performance review (deep dive analysis) • bottom 10, bottom 20 • Mainly been done for HTC_POS and TX_NEW (including linkage) • Currently also looking at TX_RET, TX_VIRAL, TX_UNDETECT

• Partner/district performance meetings • Review of deep dive analysis • Overall bottle-neck analysis • Formulation of remediation plans/process

• Increase in frequency of performance monitoring • Use of preliminary data from the field (monthly) • Both district and facility performance data

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IPs Remediation Process for Districts and Facilities

• Prioritization of districts, but working with all district teams

• Elaborate/utilize data from facility performance review (deep dive analysis)

• District performance meetings • Engagement of both IP and DOH district teams • Revision of district bottle-neck analysis + remediation plans

(DIP) • Revision of facility bottle-neck analysis + remediation plans

(DIP)

• Implementation of remedial interventions with strong focus on linkage, treatment initiation, VL documentation/suppression

• Increase in frequency of performance monitoring • Weekly data reviews for poorest performing facilities

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Stakeholder Engagement Plan Update

• Draft Stakeholder Engagement Plan provided to PFIP Management Committee

• Discussions with SANAC Civil Society Forum to set meetings with key sectors to review COP15 results, COP16 targets and plans for COP17, data presented at forum meetings

• Discussions with PLHIV advocacy groups, TAC, NAPWA, SARELA, PWN. Focus discussions on common program areas and potential collaborations

• Discussions with external partners, GFATM, BMGF, bilateral and multilaterals (Health Partners Forum)-program updates and donor collaborations

• Working to engage early and increase participation in review of data, strategies and draft SDS. Circulation of data/reports and publication of reports on PEPFAR website

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South Africa PEPFAR Priority Districts

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27 High-

burden

Districts

Men: Who is infecting whom?

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PEPFAR’s Sustainability Index Dashboard – Summary COP16 (https://www.pepfar.gov/documents/organization/260434.pdf)

Technical Area 2015 2016

Biomedical Prevention (VMMC) $ 36 209 874 $ 36,209,626

Sexual Prevention $ 13,480,721 $ 23,783,839

PMTCT $ 15,465,085 $ 11,827,129

Adult Care and Treatment $ 144,942,808 $ 159,087,491

Pediatric Care and Treatment $ 34,972,968 $ 33,534,860

ARV Drugs - $ -

Counseling and Testing $ 18,426,774 $ 26,588,387

OVC $ 42,939,925 $ 30,840,965

Laboratory Infrastructure $ 4,055,007 $ 4,025,545

TB/HIV $ 38,366,975 $ 24,475,547

Subtotal: Prevention, Treatment and Care $ 353,602,176 $ 350,373,390

Health Systems Strengthening $ 17,520,517 $ 17,393,249

Strategic Information $ 8,863,933 $ 9,219,988

Management and Operations $ 33,013,374 $33,013,373

Total: All Program Areas 413,000,000 $ 410,000,000

South Africa PEPFAR Funding COPs 2015-17

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Additional funding:

COP15/16 $67m DREAMS

COP16 $24m VMMC

COP17 planned funding :

$410 million base,

$33 million AGYW/DREAMS

$51 m VMMC funding

*Pending $40 m for additional

case finding and Tx-new

COP17 Priority Issues (pending GoSA concurrence through PFIP Management and Steering committees)

• Achievement of the 90s in the four highest HIV burdened districts (kz uMgungundlovu District Municipality, kz eThekwini Metropolitan Municipality, gp Ekurhuleni Metropolitan Municipality, and gp City of Johannesburg Metropolitan Municipality)

• Continued progress towards the 90s in the remaining 23 highest burdened districts.

• Targeted testing, increased positives yield through community and clinical settings for 15-24 y.o. age range for women and 20-30 y.o. for men.

• Prevention in under 30 year olds. Continuing voluntary male medical circumcision for 15-39 year olds towards reaching saturation (80% coverage in 27 focus districts).

• Continued support for differentiated models of care, community ART support structures and multi-month ARV resupply.

• Continued rollout of same day initiation and test and treat.

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COP17 Planning Timeline

• 23 January - 10 February: Bilateral PFIP Work Streams and Management Committee, Civil Society and External Consultations. PEPFAR SA engages to review with stakeholders in various fora. Discussions of key program areas of COP17 building on COP16, solicitation of written feedback to USG staff, and making use of summary COP15 results

• 15 February: Draft COP17 submission due to Office of Global AIDS Coordinator (OGAC) for discussion at a Washington DC USG Management Meeting (18-24 February)

At conclusion of WDC Management Meetings- PEPFAR SA will provide a summary of changes from the draft COP17 submitted.

• By 10 March: Bilateral and external stakeholders will have an opportunity to provide written

input and feedback on country goals, targets and feedback prior to the final COP submission.

• 13 March: COP17 due

• By 15 April: Bilateral and external stakeholders will have an opportunity to provide written input and feedback on country goals and targets in COP17 submission prior to review meetings with OGAC in Johannesburg.

• 24-26 April: In-person COP review by SGAC and other stakeholders in Johannesburg

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COP16 Community Grants – Applications Due: 15 March 2017

Eligible districts for applications:

• Eastern Cape: Alfred Nzo, Buffalo City, Chris Hani, O R Tambo, Amatole • Free State: Lejweleputswa, Thabo Mofutsanyane • Gauteng: City of Johannesburg, City of Tshwane, Ekurhuleni, Sedibeng • KwaZulu-Natal: eThekwini, Ugu, uMgungundlovu, uThukela, uThungulu/King Cetshwayo,

Zululand, Harry Gwala • Limpopo: Capricorn, Mopani • Mpumalanga: Ehlanzeni, Gert Sibande, Nkangala • North West: Bojanala Platinum, Dr. Kenneth Kaunda, Ngaka Modiri Molema • Western Cape: City of Cape Town (focusing on townships, informal settlements)

More information and application details:

https://za.usembassy.gov/our-relationship/pepfar/hivaids-community-grants/

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COP16 SDS, COP17 Guidance, PEPFAR targets and results

COP 2016 Strategic Directions Summary (SDS)

https://www.pepfar.gov/documents/organization/257632.pdf.

COP17 Planning Guidance and Technical Considerations

https://www.pepfar.gov/documents/organization/267162.pdf

Targets and results information available for COP16 are found at PEPFAR's

Panorama Spotlight.

https://data.pepfar.net/quarterlyData/

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Thank you!

Questions?

Charles Pill South Africa Coordinator Presidents Emergency Plan for AIDS Relief (PEPFAR) Embassy of the United States of America 877 Pretorius Street, Arcadia Pretoria, South Africa 0083 Tel: +27 (0) 872859646 Mobile: +27 (0) 791116523 Fax: +27 12 342-6167 Email: Pillc@state.gov

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